A 5-month-old male infant presents to your office in January. His mother complains that his cheeks are "red and scaly." She's concerned that they are uncomfortable, since she's noticed him scratching them. The rash has worsened since winter started. Otherwise, he has no medical history. Family history is relevant for asthma and some seasonal allergies. On exam, his cheeks bilaterally are erythematous with erosion, scaling and excoriated papules and plaques. Small, similar appearing patches are also present on his chest. What is the most likely outcome for this condition?

A 7-day-old female presents with her parents to the pediatri...

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A 38-year-old woman with a history of systemic lupus erythem...

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A 16-year-old female presents to her primary care physician with worsening facial acne over the last several months. She states that she first developed sparse pimples around age 12, and she used over-the-counter face cleansers containing salicylic acid with moderate improvement. She was prescribed a topical retinoid two months ago when her acne first started to worsen, but she has been unable to use it consistently due to excessive skin drying. She still feels that her acne is poorly controlled. She states that her skin seems to break out more around her menstrual period, which occurs every 28 days. The patient has a past medical history of migraines with aura, for which she sometimes takes sumatriptan. Her mother has a history of hypertension, and her father died of a myocardial infarction at age 51. The patient is a junior in high school and plays varsity soccer. She denies use of alcohol, tobacco, and drugs and has never been sexually active. Her temperature is 98.2°F (36.7°C), pulse is 70/min, blood pressure is 117/61 mmHg, respirations are 14/min, and oxygen saturation is 99% on room air. Cardiopulmonary exam is unremarkable. A representative portion of her facial skin exam is shown in Figure A. Which of the following is the best next step in management?

A 17-year-old wrestler presents to your office complaining of the rash seen in Figure A. He states that it is not painful but is very itchy. Several of his teammates have developed the rash as well. He has not tried any therapies for the rash. What is the most appropriate treatment at this time?

A 45-year-old morbidly obese woman with a history of asthma ...

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A 64-year-old man who has not seen a physician in over 20 ye...

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A 28-year-old female presents to her gynecologist with one y...

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A 4-day-old female presents with her parents to the pediatri...

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A 17-year-old girl presents to a women's health clinic requesting contraception. She is prescribed combination estrogen-progesterone oral contraceptives. The patient returns 3 weeks later stating that she has gained 10 kilograms of body weight. In addition she complains of headaches of new onset. On exam you note a pudgy, overweight and disgruntled young woman who aggressively blames you for the weight change stating that her boyfriend left her and wants to be taken off of oral contraceptives. Otherwise there are no other abnormalities. Her blood pressure is 145/90 mmHg with a pulse of 90/minute. Due to her recent stress she has began smoking. Which of the following symptoms are attributable to this patient's recent medication change?

A 54-year-old African American man presents to the emergency...

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A 21-year-old African-American male with a past medical hist...

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A 3-year-old girl presents to her primary care provider for fatigue. Her parents report that the patient has been eating less than usual and is less interested in playing for about one week. Two weeks ago, the patient was healthy other than an upper respiratory infection for which she had received an unknown antibiotic. During this time period her mother noted that her urine appeared abnormally dark. Her parents report recent travel to Ireland, where they have family and the child was born. They deny any other travel but endorse contact with a cousin who was diagnosed with infectious mononucleosis two months ago. Additonally, they report that the patient’s mother has had similar episodes of pallor throughout her life. Her temperature is 98.0°F (36.7°C), blood pressure is 98/72 mmHg, pulse is 99/min, and respirations are 22/min. On physical exam, she is noted to have conjunctival pallor and icteric sclera. Laboratory tests are performed and reveal the following: Leukocyte count: 10,200/mm^3 Hemoglobin: 8.7 g/dL Hematocrit: 26% MCV: 94 um^3 Platelet count: 302,000/mm^3 Reticulocyte index (RI): 4.7% A peripheral smear is performed and can be seen in Figure A. Which of the following is used to diagnose this patient’s condition?

A 6-month-old male presents to the emergency department with...

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An 82-year-old man presents to the emergency department for ...

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A 27-year-old Caucasian female presents to her physician for...

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A 37-year-old man with a history of depression has a two-yea...

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A 3-year-old male presents to the pediatrician for a well ch...

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A 64-year-old woman presents to the emergency room with complaints of severe, whole-body itching. She states that she first noticed her symptoms while in the bathtub at home. She has never had symptoms like this before. However, over the previous several months she has had episodes of severe joint swelling and pain in her hands as well as redness, burning pain, and swelling of her hands and feet. Her past medical history is significant for type II diabetes mellitus, hypertension, and osteoporosis for which she takes metformin, enalapril, and alendronate, respectively. In addition, she was found to have a deep vein thrombosis of her left leg three months prior to presentation. The patient’s temperature is 98.6°F (37.0°C), pulse is 80/min, blood pressure is 135/85 mmHg, and respirations are 13/min. Physical exam is notable for a woman in discomfort with excoriations over the skin on her forearms. The patient’s laboratory tests are shown below. Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 5.0 mEq/L HCO3-: 22 mEq/L BUN: 19 mg/dL Glucose: 130 mg/dL Creatinine: 1.0 mg/dL Hematocrit: 64% Leukocyte count: 19,000 cells/mm^3 with normal differential Platelet count: 900,000/mm^3 What is the best next step in treatment?

A 25-year-old woman presents to her primary care physician c...

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A 24-year-old G1P0 at 20 weeks gestation presents for a rout...

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A 26-year-old G2P1001 presents for a routine obstetric visit at 13 weeks gestation complaining of increased vaginal discharge for one week. The discharge is “white and clumpy” with accompanying severe vulvar itching. The patient has no other complaints. She has no past medical history, and her previous delivery was a spontaneous vaginal delivery. She states that she has been using panty liners for the last month or so due to mild stress incontinence, and she has no new sexual partners. At this visit, her temperature is 98.7 °F (35.1 °C), blood pressure is 119/74 mmHg, pulse is 82/min, and respirations are 14/min. The patient has no evidence of oral thrush. On pelvic exam, the vulva is erythematous with multiple excoriations. Speculum exam findings are shown in Figure A. Wet mount of a vaginal swab is shown in Figure B. Which of the following is the best treatment for this patient?

A 17-year-old male presents to the emergency department afte...

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A 37-year-old Mexican man presents to his neurologist for ne...

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A 74-year-old man is being evaluated for a six month history...

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A 7-year-old immigrant child is brought to the pediatrician ...

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A 58-year-old man with past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and tobacco use is brought to the emergency department by his sister for confusion. His sister reports that she and the patient were watching television together when the patient asked her to call their mother, who is deceased. His sister then noticed that he had difficulty walking to the bathroom. She reports that the patient has started drinking more since losing his job several months ago, but she insists that he has not had any alcohol while she was with him today. The patient’s home medications include hydrochlorothiazide, rosuvastatin, and albuterol as needed. His temperature is 97.9°F (36.6°C), blood pressure is 145/93 mmHg, pulse is 82/min, respirations are 12/min, and SpO2 is 96%. On physical exam, he is alert and oriented to person, place, and time. His eyes appear to flick to the right when he is asked to look to the left. The patient’s blood alcohol level is normal. Additional laboratory tests are performed and reveal the following: Leukocyte count: 7,200/mm^3 Hemoglobin: 9.1 g/dL Hematocrit: 29% Mean corpuscular volume: 109 µm^3 Platelet count: 188,000/mm^3 A peripheral smear is performed and can be seen in Figure A. What is the most likely cause of the findings seen on peripheral smear?

A 72-year-old African American man with a past medical histo...

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A 32-year-old G1P0 presents to the antenatal testing unit at 32 weeks gestation for a non-stress test (NST) due to gestational diabetes. She states that yesterday she had several episodes of diarrhea and vomited once after attending a company picnic two days ago. She took loperamide with symptomatic relief. She is worried that she is dehydrated but otherwise feels well and has recovered from her gastrointestinal illness. The patient was diagnosed with gestational diabetes after routine screening in the second trimester and has been started on insulin after unsuccessful attempts at lifestyle management. She also has a medical history of migraines and gastroesophageal reflux disorder. The patient has a 15-pack-year smoking history and quit in her first month of pregnancy. She denies alcohol or drug use. At this visit, her temperature is 98.5°F (36.9°C), blood pressure is 122/82 mmHg, pulse is 84/min, and respirations are 14/min. A representative portion of the NST is initiated and shown in Figure A. Which of the following is the most likely explanation for this patient’s non-stress test results?

A 32-year-old G1P0000 presents to labor and delivery triage ...

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A 31-year-old G1P0000 presents to the obstetric service for a scheduled induction of labor at 39 weeks due to poorly controlled gestational diabetes. Her pregnancy was largely uncomplicated aside from abnormal 1-hour and 3-hour glucose tolerance tests, for which diet and lifestyle management were initially recommended. Due to poor glycemic control despite these interventions, the patient was started on insulin. Postprandial glucose levels were in the 170-180 mg/dL range throughout the remainder of her pregnancy. She has a family history of diabetes in her mother and grandmother, as well as hypertension in her father and preeclampsia in her sister. The patient had an appropriate weight gain of 26 pounds during this pregnancy, with a pre-pregnancy BMI of 22.4 kg/m^2. At her last ultrasound one month ago, the estimated fetal weight was 4,100 g, and upon arrival on the labor floor, the updated measurement is 4,560 g. The patient continues to desire a vaginal delivery and is subsequently induced. After 24 hours, the infant’s head delivers but the shoulders do not. The mother’s hips are flexed and pressure is applied to the suprapubic region without improvement, and internal rotation is ultimately required to deliver a male infant after 3 minutes. One hour after delivery, the infant is found to have an absent Moro reflex on the left side. He is shown in Figure A. Which of the following would have most likely prevented this infant’s presentation?

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A 7-year-old male presents with a chief complaint of right hip pain for the past 2 days. He reports gradual onset of pain and is currently refusing to bear weight on the leg. He is afebrile with BP 110/60 and HR 79. Physical exam reveals no swelling or warmth surrounding the joint; he is sitting with the right hip flexed, abducted, and externally rotated. Active range of motion is reduced secondary to pain. Work-up yields no abnormalities on a complete blood count or erythrocyte sedimentation rate. Which of the following is the best next step in management of this patient?

A 27-year-old G1P1001 is recovering in the postpartum unit t...

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An 11-year-old boy is brought to the pediatrician by his mot...

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A 52-year-old woman with hypertension presents to your clini...

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A 37-year-old woman presents to her primary care physician f...

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A 16-year-old female presents to her physician’s office afte...

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A female patient presents to her primary care physician due to pain, changing skin texture, dimpling, and an inverted nipple areolar complex (Figure A). The doctor is immediately concerned that which of the following structures has been infiltrated by malignancy?

A 52-year-old G0P0 presents to her gynecologist for an annua...

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A 42-year-old G3P3003 presents for a 6-week postpartum obste...

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A 40-year-old man is brought to the emergency room after bei...

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A 54-year-old man presents to the emergency department for f...

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A pregnant mother presented to the obstetrician for her 20 week check-up. On ultrasound, a cleft lip was visualized, along with a mass protruding from the umbilicus. At the time of delivery, the physician notes that the shape of the child's feet is also abnormal. What is the most likely etiology for this patient's condition?

An 11-year-old male presents to the pediatrician to be evalu...

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